Authors

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
78th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
Munich,
16.-20.05.2007.
DÃ¼sseldorf, KÃ¶ln: German Medical Science; 2007. Doc07hno121

Outline

Background: Nocturnal positive pressure ventilation (nCPAP and related methods) aims at keeping the airways open and avoiding a collapse due to muscle relaxation while sleeping. Usually pressures ranging from 5 to 15 mbar are applied. In contrast, the esophageal closing pressure is normally at least 30 mbar; however, it can drop considerably over long periods (for instance during gastroesophageal reflux disease).

Method: This is the case report of a patient who had to be brought to the intensive care unit due to symptoms of an “acute abdomen” which manifested during nCPAP pressure adjustment. The hypothesis that this was caused by gastrointestinal air insufflation during nCPAP therapy was verified on the basis of a survey conducted among 30 nCPAP patients.

Observations: 19 patients gave feedback. 2 out of these 19 patients (10 %) reported flatulence which had reoccurred in connection with nocturnal ventilation therapy. One patient felt disturbed by the degree of flatulence, the others hardly felt bothered.

Conclusion: Gastrointestinal air insufflation is a common side-effect of nocturnal hyperbaric therapy. Adverse effects can range from a low degree of flatulence to alarming abdominal tympanites. In most cases patients will not report these symptoms voluntarily. Therefore, one should regularly ask patients about such symptoms as this could be one of the reasons why they reject CPAP therapy.